150-13-.01 Conscious Sedation Permits.

(1) When the intent is minimal sedation (anxiolysis), which is defined as a minimally
depressed level of consciousness that retains the patient’s ability to independently and
continuously maintain an airway with unaffected ventilatory and cardiovascular function
and respond normally to tactile and verbal stimulation, a permit for conscious sedation is
not required.

(a) When the intent is minimal sedation for adults, the initial dosing is no more than the
maximum recommended dose (MRD) of a drug that can be prescribed for unmonitored
home use. Nitrous oxide/oxygen may be used in combination with a single enteral drug in
minimal sedation. For adults, supplemental dosing that may be necessary for prolonged
procedures should not exceed one-half of the initial drug dose and should not be
administered until the dentist has determined that the clinical half-life of the initial dosing
has passed. The total aggregate dose must not exceed 1.5x the MRD on the day of
treatment.

(b) The use of preoperative sedatives for children (age 12 and under) except in
extraordinary situations must be avoided due to the risk of unobserved respiratory
obstruction during transport by untrained individuals. Children can become moderately
sedated despite the intended level of minimal sedation. Should this occur, the guidelines
for moderate sedation apply. For children, the American Dental Association supports the
use of the American Academy of Pediatrics/American Academy of Pediatric Dentists
Guidelines for Monitoring and Management of Pediatric Patients During and After
Sedation for Diagnostic and Therapeutic Procedures.

(2) No dentist shall administer conscious sedation at the moderate level in Georgia in
accordance with the definition of conscious sedation as defined by O.C.G.A. 43-11-1
unless such dentist possesses a permit based on a credentials review. The permits issued
are Moderate Enteral Conscious Sedation or Moderate Parenteral Conscious Sedation.

(3) Moderate Conscious Sedation is defined as a drug-induced depression of
consciousness during which patients respond purposefully to verbal commands, either
alone or accompanied by light tactile stimulation. No interventions are required to
maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular
function is usually maintained.

(4) Moderate Enteral Conscious Sedation is any technique of administration in which the
drugs are absorbed through the gastrointestinal tract or oral mucosa, i.e. oral, rectal, and
sublingual.

(a) To obtain a Moderate Enteral Conscious Sedation Permit for adults, a dentist must
provide certification of the following:

2. Completion of a continuing education course of a board approved organization, which
consists of a minimum of twenty-four (24) hours of didactic instruction plus management
of at least ten (10) adult case experiences which provides competency in moderate enteral
conscious sedation which may include simulated cases.

(b)To obtain a Moderate Enteral Conscious Sedation Permit for pediatric patients (age 12
and under) a dentist must provide certification of a continuing education course of a
board approved organization in pediatric sedation including twenty-four (24) hours of
pediatric-specific instruction after adult training and ten (10) pediatric patient experiences
to include supervised administration of sedation of at least five (5) patients; or
completion of an ADA-accredited postdoctoral training program that provides pediatric
sedation experience commensurate with these guidelines.

(2) Completion of a continuing education course of a board approved organization
consisting of a minimum of sixty (60) hours of didactic instruction plus management of at
least twenty (20) patients, which provides competency in moderate parenteral conscious
sedation.

(b) To obtain a Moderate Parenteral Conscious Sedation Permit for pediatric patients (age
12 and under) a dentist must provide certification of a continuing education course of a
board approved organization in pediatric sedation including not less than sixty (60) hours
didactic and supervised administration of sedation of twenty
(20) patients; or completion of an ADA-accredited postdoctoral training program that
provides pediatric sedation experience commensurate with these guidelines.

(6) The dentist issued a permit in either Moderate Enteral Conscious Sedation or
Moderate Parenteral Conscious Sedation shall maintain a properly equipped facility for
the administration of such sedation, staffed with appropriately trained and supervised
personnel. The facility must have equipment capable of delivering positive pressure
oxygen ventilation, a pulse oximeter, suction equipment that allows aspiration of the oral
and pharyngeal cavities, an operating table or chair that allows for the patient to be
positioned to maintain an airway, a firm platform for cardiopulmonary resuscitation, a
fail-safe inhalation system if nitrous oxide/oxygen is used, equipment necessary to
establish intravascular access, equipment to continuously monitor blood pressure and
heart rate, appropriate emergency drugs per ACLS or PALS protocol, a manual or
automatic external defibrillator, and a recovery area with available oxygen and suction.
All of the aforementioned equipment, drugs, and supplies must be stationary and not
subject to transfer from one facility to another. The applicant must submit verification
that the facility meets the above requirements and shall be subject to an on-site
inspection. The dentist and all support personnel must be certified in cardiopulmonary
resuscitation at the basic life support healthcare provider level given by a board approved
sponsor with update not to exceed two years per board rules 150-3-.08, 150-3-.09, 150-5-
.04, 150-5-.05. Additionally, the dentist must have current certification in advanced
cardiovascular life support (ACLS) for adult permits or pediatric advanced life support
(PALS) for pediatric permits or an appropriate dental sedation/anesthesia emergency
management course as approved by the board.

(a) The dentist must take four (4) hours of continuing education every two (2) years in
pharmacology, anesthesia, emergency medicine or sedation, as part of the 40 hour
requirement for license renewal, to maintain certification for the Enteral and/or Parenteral
Conscious Sedation Permits. Certification of this continuing education must be submitted
at renewal.

(b) The Georgia Board of Dentistry shall be given a written, thirty (30) day advance
notification of the relocation of a facility, the addition of a facility or significant change
to the facility.

(c) When a Certified Registered Nurse Anesthetist (CRNA) is permitted to function under
the direction and responsibility of a dentist for the administration of conscious sedation,
the operating dentist must have completed training and hold a valid conscious sedation
permit issued by the board that incorporates the level and mode of sedation administered
by the CRNA.

(d) The dentist must be certified in cardiopulmonary resuscitation at the basic and
advanced levels and all support personnel who provide direct hands-on patient care must
be certified in cardiopulmonary resuscitation at the basic life support level given by a
board approved provider with an update not to exceed two years. While any conscious
sedation procedure is underway, a minimum of two support personnel certified in basic
cardiopulmonary resuscitation must be present.

(7) The requirements as set forth in this rule apply to all new permit applicants upon its
effective date. Current, active sedation permit holders are grandfathered for educational
requirements and will have until December 31, 2011 to comply with facility requirements
including monitoring and emergency equipment, drugs, and supplies, and periodic
emergency training requirements for the dentist and all support personnel.

(8) Permit fees: As shown in the schedule of fees adopted by the Board of Dentistry.

(9) Renewal Fees: As shown in the schedule of fees adopted by the Board of Dentistry.

(10) Late Renewal Fees: As shown in the schedule of fees adopted by the Board of
Dentistry.

Disclaimer: Displayed codes may not be the most recent version. The State of Georgia may have more current or accurate information. ESHS makes no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site. Please check official sources.

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